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Ontario is delisting the prescription painkiller OxyContin — and the drug that will soon replace it — from the province’s drug benefit program.

The change, revealed Friday, is an attempt to curb an addiction epidemic in the province by making it harder for physicians to prescribe — and patients to get — the highly addictive drug.

In recent years, OxyContin prescriptions have skyrocketed in Ontario. The drug, sometimes called “hillbilly heroin,” is sold on the street for its heroin-like high and causes hundreds of overdose deaths each year.

This is the first time the province has delisted a drug due to its addictive properties. However, the ministry said it is not uncommon to pull drugs due to safety concerns.

“Overprescribing and abuse of opioids — OxyContin in particular — is a problem in Ontario that we take very seriously,” provincial Health Minister Deb Matthews said Friday.

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Physicians, addictions specialists and those who treat chronic pain said removing OxyContin and its successor from the Ontario Drug Benefit program will help prevent people from abusing the drug while still helping those who depend on it for pain management, including those with spinal cord injuries and patients in palliative care.

“Ultimately, the drug gets out into the population via the prescription pad of physicians,” said Dr. Irfan Dhalla, a physician and scientist at St. Michael’s Hospital.

“The new mechanisms will hopefully result in physicians more carefully considering both the benefits and the risks before they prescribe OxyContin. Over time, what we will likely see is a reduction in the number of people who are prescribed OxyContin and as a consequence hopefully see fewer people becoming addicted . . . and fewer people dying of OxyContin overdoses.”

Purdue Pharma, the company that makes OxyContin, will replace the controversial medication with a new formulation of the drug called OxyNEO at the end of February. The new drug is formulated in such a way that it is more difficult to crush, and therefore less likely to be abused through injecting or snorting.

On Friday, the Ontario Ministry of Health notified physicians that OxyNEO will only be available through the province’s Exceptional Access Program — the mechanism that allows doctors, on behalf of their patients, to request access to drugs not listed on the provincial formulary. OxyNEO will also be available to patients who are in palliative care and whose treatment is being supervised by a physician.

The changes take affect Feb. 29.

While many have heralded the move to limit access to OxyContin and its successor, those in remote First Nations communities in Northern Ontario are concerned the switch to OxyNEO will leave thousands facing involuntary and potentially dangerous withdrawal from the potent painkiller.

Among the Nishnawbe Aski Nation, or NAN, which represents 49 First Nation communities in Northern Ontario, at least half of residents are addicted to OxyContin.

On Wednesday, Health Canada pulled OxyContin from the Non-Insured Health Benefits Program, which provides drug coverage for more than 800,000 registered First Nations and recognized Inuit. A spokesperson for the agency said most of those addicted to OxyContin in those communities do not receive the drug through government-funded legal prescriptions.

Regardless of where people obtain the drug, grand chief Stan Beardy told the Star that without treatment, including detox and opioid replacement therapy, thousands will suffer withdrawal, communities will face a spike in crime and those seeking a high will turn to more dangerous drugs, such as heroin.

Diane McArthur, assistant deputy minister and executive officer of Ontario Public Drug Programs, said by delisting OxyContin and OxyNEO from the ODB program, the province is tightening the criteria under which the drugs can be prescribed.

Discussions to delist the drug started about the time Purdue Pharma sent notice the company was replacing OxyContin with OxyNEO, which was approved by Health Canada on Aug. 22, 2011.

According to a statement from the company, OxyNEO was developed to make the tablets “more difficult to be manipulated for the purpose of misuse and abuse.” OxyNEO tablets, which provide the same pain relief as OxyContin, have been “hardened by a unique process to reduce the risk of being broken, crushed or chewed. The tablets also become gel-like when in contact with water,” said Randy Steffan, Purdue Pharma’s vice president of corporate affairs in a statement.

The U.S. Food and Drug Administration approved the new formulation of OxyContin in April, 2010. The agency required Purdue Pharma to conduct a postmarket study to determine whether the new version reduces misuse and abuse of the drug. Health Canada has also asked the company for clinical data showing OxyNEO is indeed tamper resistant.

OxyContin, which is up to twice as strong as morphine, is a long-acting version of the opioid oxycodone.

McArthur said between 1991 and 2009 Ontario saw a 900 per cent increase in oxycodone prescriptions. Each year, between 300 and 400 people die from overdoses involving prescription opioids, primarily OxyContin, she said. These statistics were released in the statement sent to physicians Friday notifying them of the change to delist both OxyContin and OxyNEO from the Ontario Drug Benefit program.

McArthur said the province received a wide range of input on the decision and that it was important to “find a balance between ensuring access for people who need the drug and to try to deal with some of the abuse problems occurring in Ontario.”

Patients who currently receive OxyContin under the Ontario Drug Benefit program will continue to get the drug for one month. After April 2, these patients will receive coverage for OxyNEO for an additional year. Beyond that time, they will need approval by the Exceptional Access Program.

For people who are using the drugs for addiction purposes, McArthur said the province is concerned about the potential for substituting one form of drug with another, adding that “it’s an overall challenge for society.”

Dr. Andrea Furlan, a physician in the Toronto Rehabilitation Institute’s musculoskeletal rehabilitation program, said Ontario’s move will not affect the vast majority of patients who rely on OxyNEO to manage their pain, even those who will be required to access the drug through the Exceptional Access Program.

However, she said, for some patients, particularly those who do not have family physicians, it may be difficult to get new prescriptions for OxyNEO.

“The physician and pharmacist communities, we all see this as a good step to go. Though we understand there will be some difficulties, we understand this has to be done. We will figure out a way to solve our patients’ problems.”

People who are addicted to OxyContin and who will not be able to get enough pills to satisfy their addiction will experience painful withdrawal, including nausea and terrible stomach cramps. But, Furlan said, unlike withdrawal from alcohol addiction, suddenly going off opioids is not life-threatening.

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